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Samizadeh MA, Fallah H, Toomarisahzabi M, Rezaei F, Rahimi-Danesh M, Akhondzadeh S, Vaseghi S. Parkinson's Disease: A Narrative Review on Potential Molecular Mechanisms of Sleep Disturbances, REM Behavior Disorder, and Melatonin. Brain Sci 2023; 13:914. [PMID: 37371392 DOI: 10.3390/brainsci13060914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Parkinson's disease (PD) is one of the most common neurodegenerative diseases. There is a wide range of sleep disturbances in patients with PD, such as insomnia and rapid eye movement (REM) sleep behavior disorder (or REM behavior disorder (RBD)). RBD is a sleep disorder in which a patient acts out his/her dreams and includes abnormal behaviors during the REM phase of sleep. On the other hand, melatonin is the principal hormone that is secreted by the pineal gland and significantly modulates the circadian clock and mood state. Furthermore, melatonin has a wide range of regulatory effects and is a safe treatment for sleep disturbances such as RBD in PD. However, the molecular mechanisms of melatonin involved in the treatment or control of RBD are unknown. In this study, we reviewed the pathophysiology of PD and sleep disturbances, including RBD. We also discussed the potential molecular mechanisms of melatonin involved in its therapeutic effect. It was concluded that disruption of crucial neurotransmitter systems that mediate sleep, including norepinephrine, serotonin, dopamine, and GABA, and important neurotransmitter systems that mediate the REM phase, including acetylcholine, serotonin, and norepinephrine, are significantly involved in the induction of sleep disturbances, including RBD in PD. It was also concluded that accumulation of α-synuclein in sleep-related brain regions can disrupt sleep processes and the circadian rhythm. We suggested that new treatment strategies for sleep disturbances in PD may focus on the modulation of α-synuclein aggregation or expression.
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Affiliation(s)
- Mohammad-Ali Samizadeh
- Cognitive Neuroscience Lab, Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj 3365166571, Iran
| | - Hamed Fallah
- Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran 1417935840, Iran
| | - Mohadeseh Toomarisahzabi
- Cognitive Neuroscience Lab, Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj 3365166571, Iran
| | - Fereshteh Rezaei
- Cognitive Neuroscience Lab, Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj 3365166571, Iran
| | - Mehrsa Rahimi-Danesh
- Cognitive Neuroscience Lab, Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj 3365166571, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran 13337159140, Iran
| | - Salar Vaseghi
- Cognitive Neuroscience Lab, Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj 3365166571, Iran
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Lopez R, Rivier F, Chelly J, Dauvilliers Y. Impaired glycinergic transmission in hyperekplexia: a model of parasomnia overlap disorder. Ann Clin Transl Neurol 2019; 6:1900-1904. [PMID: 31392847 PMCID: PMC6764621 DOI: 10.1002/acn3.50866] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 01/05/2023] Open
Abstract
We report sleep phenotypes and polysomnographic findings in two siblings with a novel homozygous variant of the GLRA1 gene causing hereditary hyperekplexia (HH). Both sisters had startles during wakefulness and sleep, sleep terrors, and one had symptoms of REM sleep behavior disorder (RBD). Frequent startles were found in NREM sleep associated with NREM parasomnias in deep sleep. In REM sleep, both had motor behaviors and increased phasic/tonic muscle activities confirming RBD. Clonazepam improved startles, motor behaviors, and muscle activities in REM sleep. Impaired glycinergic transmission in human HH could be involved in the pathophysiology of RBD and NREM parasomnias.
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Affiliation(s)
- Régis Lopez
- Département de Neurologie, Unité des Troubles du Sommeil, CHU Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
| | - François Rivier
- Department of Pediatric Neurology, Neuromuscular Diseases Reference Center AOC, CHU Montpellier, France.,PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Jamel Chelly
- Service de Diagnostic Génétique, Hôpital Civil de Strasbourg, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,IGBMC, INSERM, CNRS, Université de Strasbourg, Strasbourg, France
| | - Yves Dauvilliers
- Département de Neurologie, Unité des Troubles du Sommeil, CHU Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
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Impaired GABA and glycine transmission triggers cardinal features of rapid eye movement sleep behavior disorder in mice. J Neurosci 2011; 31:7111-21. [PMID: 21562273 DOI: 10.1523/jneurosci.0347-11.2011] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a neurological disease characterized by loss of normal REM motor inhibition and subsequent dream enactment. RBD is clinically relevant because it predicts neurodegenerative disease onset (e.g., Parkinson's disease) and is clinically problematic because it disrupts sleep and results in patient injuries and hospitalization. Even though the cause of RBD is unknown, multiple lines of evidence indicate that abnormal inhibitory transmission underlies the disorder. Here, we show that transgenic mice with deficient glycine and GABA transmission have a behavioral, motor, and sleep phenotype that recapitulates the cardinal features of RBD. Specifically, we show that mice with impaired glycine and GABA(A) receptor function exhibit REM motor behaviors, non-REM muscle twitches, sleep disruption, and EEG slowing--the defining disease features. Importantly, the RBD phenotype is rescued by drugs (e.g., clonazepam and melatonin) that are routinely used to treat human disease symptoms. Our findings are the first to identify a potential mechanism for RBD--we show that deficits in glycine- and GABA(A)-mediated inhibition trigger the full spectrum of RBD symptoms. We propose that these mice are a useful resource for investigating in vivo disease mechanisms and developing potential therapeutics for RBD.
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Brooks PL, Peever JH. Glycinergic and GABA(A)-mediated inhibition of somatic motoneurons does not mediate rapid eye movement sleep motor atonia. J Neurosci 2008; 28:3535-45. [PMID: 18385312 PMCID: PMC6671096 DOI: 10.1523/jneurosci.5023-07.2008] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 01/28/2008] [Accepted: 02/18/2008] [Indexed: 01/29/2023] Open
Abstract
A hallmark of rapid eye movement (REM) sleep is a potent suppression of postural muscle tone. Motor control in REM sleep is unique because it is characterized by flurries of intermittent muscle twitches that punctuate muscle atonia. Because somatic motoneurons are bombarded by strychnine-sensitive IPSPs during REM sleep, it is assumed that glycinergic inhibition underlies REM atonia. However, it has never been determined whether glycinergic inhibition of motoneurons is indeed responsible for triggering the loss of postural muscle tone during REM sleep. Therefore, we used reverse microdialysis, electrophysiology, and pharmacological and histological methods to determine whether glycinergic and/or GABA(A)-mediated neurotransmission at the trigeminal motor pool mediates masseter muscle atonia during REM sleep in rats. By antagonizing glycine and GABA(A) receptors on trigeminal motoneurons, we unmasked a tonic glycinergic/GABAergic drive at the trigeminal motor pool during waking and non-rapid eye movement (NREM) sleep. Blockade of this drive potently increased masseter muscle tone during both waking and NREM sleep. This glycinergic/GABAergic drive was immediately switched-off and converted into a phasic glycinergic drive during REM sleep. Blockade of this phasic drive potently provoked muscle twitch activity in REM sleep; however, it did not prevent or reverse REM atonia. Muscle atonia in REM even persisted when glycine and GABA(A) receptors were simultaneously antagonized and trigeminal motoneurons were directly activated by glutamatergic excitation, indicating that a powerful, yet unidentified, inhibitory mechanism overrides motoneuron excitation during REM sleep. Our data refute the prevailing hypothesis that REM atonia is caused by glycinergic inhibition. The inhibitory mechanism mediating REM atonia therefore requires reevaluation.
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Affiliation(s)
- Patricia L Brooks
- Department of Cell and Systems Biology, Systems Neurobiology Laboratory, University of Toronto, Toronto, Ontario, Canada M5S 3G5
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Biochemical control of airway motor neurons during rapid eye movement sleep. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2008; 605:437-41. [PMID: 18085313 DOI: 10.1007/978-0-387-73693-8_76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Shahar E, Raviv R. Sporadic major hyperekplexia in neonates and infants: clinical manifestations and outcome. Pediatr Neurol 2004; 31:30-4. [PMID: 15246489 DOI: 10.1016/j.pediatrneurol.2003.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2003] [Accepted: 12/08/2003] [Indexed: 10/26/2022]
Abstract
The aim of the present study is to report on the syndrome of sporadic major hyperekplexia during the neonatal period and early infancy, diagnosed in 39 patients at an average age of 3.3 months, the most severely affected during the first month of life. The patients mainly presented with marked irritability and recurrent startles in response to handling or even minute sounds, accompanied by rhythmic jerky movements and occasionally breath-holding episodes. Family history was negative for hyperekplexia, although eight parents reported jerky leg movements during sleep. The hallmark of hyperekplexia consisted of a hyper-alert gaze and an exaggerated startle with delayed habituation, also elicited by nose tapping and air blowing on the face accompanied by increasing rigidity. Nine severely affected infants, presenting with relentless startles, marked stiffness, violent rhythmic jerks, and breath-holding episodes were treated with oral low doses of clonazepam and completely recovered. Overall, the debilitating symptoms of hyperekplexia gradually resolved in all 39 infants, and their developmental assessment by 2 years of age was within the normal range. Therefore a prompt diagnosis of hyperekplexia during the neonatal period and early infancy, and then treatment if required with benzodiazepines to alleviate the debilitating symptoms, may prevent life-threatening events and enable better feeding and handling. Establishing the diagnosis of such a relatively benign disorder with a favorable developmental outcome may avoid unjustified extensive investigations or unnecessary treatment, suspecting an ominous progressive neurologic disorder.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit and Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel
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Corner MA, van Pelt J, Wolters PS, Baker RE, Nuytinck RH. Physiological effects of sustained blockade of excitatory synaptic transmission on spontaneously active developing neuronal networks--an inquiry into the reciprocal linkage between intrinsic biorhythms and neuroplasticity in early ontogeny. Neurosci Biobehav Rev 2002; 26:127-85. [PMID: 11856557 DOI: 10.1016/s0149-7634(01)00062-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Spontaneous bioelectric activity (SBA) taking the form of extracellularly recorded spike trains (SBA) has been quantitatively analyzed in organotypic neonatal rat visual cortex explants at different ages in vitro, and the effects investigated of both short- and long-term pharmacological suppression of glutamatergic synaptic transmission. In the presence of APV, a selective NMDA receptor blocker, 1-2- (but not 3-)week-old cultures recovered their previous SBA levels in a matter of hours, although in imitation of the acute effect of the GABAergic inhibitor picrotoxin (PTX), bursts of action potentials were abnormally short and intense. Cultures treated either overnight or chronically for 1-3 weeks with APV, the AMPA/kainate receptor blocker DNQX, or a combination of the two were found to display very different abnormalities in their firing patterns. NMDA receptor blockade for 3 weeks produced the most severe deviations from control SBA, consisting of greatly prolonged and intensified burst firing with a strong tendency to be broken up into trains of shorter spike clusters. This pattern was most closely approximated by acute GABAergic disinhibition in cultures of the same age, but this latter treatment also differed in several respects from the chronic-APV effect. In 2-week-old explants, in contrast, it was the APV+DNQX treated group which showed the most exaggerated spike bursts. Functional maturation of neocortical networks, therefore, may specifically require NMDA receptor activation (not merely a high level of neuronal firing) which initially is driven by endogenous rather than afferent evoked bioelectric activity. Putative cellular mechanisms are discussed in the context of a thorough review of the extensive but scattered literature relating activity-dependent brain development to spontaneous neuronal firing patterns.
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Affiliation(s)
- M A Corner
- Academic Medical Centre, Meibergdreef 33, Netherlands Institute for Brain Research, 1105 AZ Amsterdam, The Netherlands.
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Abstract
In the last years it has become possible to regain some locomotor activity in patients suffering from an incomplete spinal cord injury (SCI) through intense training on a treadmill. The ideas behind this approach owe much to insights derived from animal studies. Many studies showed that cats with complete spinal cord transection can recover locomotor function. These observations were at the basis of the concept of the central pattern generator (CPG) located at spinal level. The evidence for such a spinal CPG in cats and primates (including man) is reviewed in part 1, with special emphasis on some very recent developments which support the view that there is a human spinal CPG for locomotion. Copyright 1997 Elsevier Science B.V.
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Vergouwe MN, Tijssen MA, Shiang R, van Dijk JG, al Shahwan S, Ophoff RA, Frants RR. Hyperekplexia-like syndromes without mutations in the GLRA1 gene. Clin Neurol Neurosurg 1997; 99:172-8. [PMID: 9350397 DOI: 10.1016/s0303-8467(97)00022-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hyperekplexia (MIM: 149400), or startle disease, is an autosomal dominant neurological disorder characterized by an extreme generalized stiffness immediately after birth, normalizing during the first years of life. Other features of this disorder are excessive startle reactions to unexpected, particularly auditory, stimuli together with a short period of generalized stiffness during which voluntary movements are impossible. Linkage analysis mapped a gene for this disorder to chromosome 5q33-q35. Subsequently, mutations in the GLRA1 gene encoding the alpha 1-subunit of the glycine receptor proved to be causally related to the disease. In the present study, mutation analysis of all exon and flanking intron sequences of this gene was performed in sporadic patients and their parents. Moreover, a branch of the original Dutch hyperekplexia family with a very severely affected individual was screened for an additional mutation in the GLRA1 gene. Except for two polymorphisms, of which one results in an amino acid change, no potentially disease causing mutations were found in the alpha 1-subunit of the glycine receptor. Together with haplotype analysis these results exclude a recessive inheritance or new mutation etiology in these hyperekplexia-like syndrome and emphasize that hyperekplexia-like syndromes can be caused by other genetic factors. The involvement of other genes encoding subunits of the functional glycine receptor complex has not been excluded.
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Affiliation(s)
- M N Vergouwe
- MGC-Department of Human Genetics, Leiden University, The Netherlands
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Cioni G, Biagioni E, Bottai P, Castellacci AM, Paolicelli PB. Hyperekplexia and stiff-baby syndrome: an identical neurological disorder? ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1993; 14:145-52. [PMID: 8509269 DOI: 10.1007/bf02335749] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hyperekplexia (startle disease) is an unusual, familial, neurological disorder characterized by abnormally enhanced startle response, followed in most cases by momentary generalized muscular stiffness. These attacks may cause the patients to fall rigidly, while remaining fully conscious. Startle symptomatology has generally an onset in infancy and is often accompanied, during the first years of life, by rigidity, sleep myoclonus, motor delay, regurgitation and apneic spells, which may cause sudden death. Stiff-baby syndrome is a familial disorder characterized by marked rigidity, with neonatal onset and gradual reduction during infancy, regurgitations, motor delay and attacks of stiffness. We report 4 new cases of hyperekplexia from two different families and another infant with stiff-baby syndrome discussing clinical, electrophysiological and genetic aspects of both neurological disorders in relation to other reported cases. We suggest a continuum between these familial syndromes, which are often misinterpreted as epilepsy or other disorders.
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Affiliation(s)
- G Cioni
- Istituto di Neuropsichiatria e Psicopedagogia dell'Età Evolutiva, Università di Pisa
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Affiliation(s)
- F Andermann
- Montreal Neurological Institute and Hospital, Quebec, Canada
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12
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Masdeu JC, Sáenz-Lope E. Reply. Ann Neurol 1984. [DOI: 10.1002/ana.410160321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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De Groen JH. Influence of diffuse brain stimulation (DBS) on human sleep. II. Sleep-induced periodic breathing with apnoea. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1979; 46:696-701. [PMID: 87315 DOI: 10.1016/0013-4694(79)90108-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The influence of diffuse brain stimulation (DBS), administered just before sleep onset, on the number of apnoeas and of sleep stage changes during the first part of the succeeding night sleep to the end of the first sleep cycle has been studied in 7 patients with sleep-induced periodic breathing with apnorea. When compared with the corresponding period of the baseline night, both phenomena are increased significantly. These results indicate that DBS influences slow periodic sleep phenomena. It is suggested that the target area for this influence might be mesencephalo-pontine reticular structures, which play a role in the generation of these slow periodic phenomena.
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